SURGICAL EXCISION OF MENINGIOMAS INVOLVING THE CLIVUS - PREOPERATIVE AND INTRAOPERATIVE FEATURES AS PREDICTORS OF POSTOPERATIVE FUNCTIONAL DETERIORATION
SURGICAL EXCISION OF MENINGIOMAS INVOLVING THE CLIVUS - PREOPERATIVE AND INTRAOPERATIVE FEATURES AS PREDICTORS OF POSTOPERATIVE FUNCTIONAL DETERIORATION
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DOI：
10.3171/jns.1994.81.6.0860
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发表时间：
1994-12-01
影响因子：
4.1
通讯作者：
WRIGHT, DC
中科院分区：
文献类型：
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作者：
SEKHAR, LN;SWAMY, NKS;WRIGHT, DC
神经功能恶化是常见的斜坡脑膜瘤手术切除后，然而，与术后恶化的危险因素的理解可以导致outcome.In 75例斜坡脑膜瘤手术超过7年的时间，以下数据进行了研究：术前变量，如提出Karnofsky量表评分，年龄，性别，和以前的操作或放射治疗的改善。磁共振成像或动脉造影的放射学结果，如肿瘤和脑干之间的蛛网膜裂平面的发展，脑干水肿，肿瘤大小，脑干压迫程度，血管包裹和基底动脉的血液供应是研究的其他数据。此外，还记录了术中发现，如蛛网膜平面的形成、血管包裹和分离困难。术后1周及随访时记录每例患者的神经和功能状态，术后早期功能恶化45例（60%），轻度（30例）至重度（3例）。在随访检查时，除4例患者外，所有患者均出现了显著改善;然而，12例患者出现了永久性术后功能障碍。统计学分析显示，早期功能恶化与术前Karnofsky量表评分、男性、蛛网膜平面缺失的放射学检查结果、脑干水肿和基底动脉的动脉造影供血之间存在显著相关性。手术特征包括难以分离、缺乏蛛网膜裂平面和肿瘤切除不完全。永久性功能恶化在统计学上与以下因素相关：基底动脉供血、分离困难、肿瘤切除不完全和术后早期功能障碍。对数回归分析显示，术后早期恶化的最重要的危险因素是肿瘤大小。大型或巨大肿瘤患者的功能恶化风险分别是小型或中型肿瘤患者的6.7至13倍。排除肿瘤大小，永久恶化的最重要因素是来自基底动脉的血液供应。这类患者永久性功能恶化的风险高4.4倍。提出了肿瘤与脑干蛛网膜和软脑膜的三个阶段的关系。基于斜坡脑膜瘤的临床研究结果，我们提出了改变这些困难病变的治疗策略的建议。
Neurological deterioration is commonly seen after surgical excision of clival meningiomas; however, an understanding of the risk factors associated with postoperative deterioration can lead to improvements in outcome.In 75 patients with clival meningiomas operated on over a 7-year period, the following data were studied: preoperative variables such as presenting Karnofsky scale score, age, sex, and prior operations or radiation therapy. Radiological findings on magnetic resonance imaging or arteriography, such as the development of the arachnoidal cleavage plane between tumor and the brain stem, brainstem edema, tumor size, extent of compression on the brain stem, vascular encasement, and blood supply from the basilar artery were among other data studied. In addition, intraoperative findings such as development of the arachnoid plane, vascular encasement, and the difficulty of dissection were noted. Finally, each patient's neurological and functional statuses were recorded at 1 week postoperatively and at follow-up examinations.Early postoperative functional deterioration occurred in 45 patients (60%) and ranged from mild (30 patients) to severe (three patients). Significant improvement had occurred by the time of follow-up examination in all but four patients; however, permanent postoperative dysfunction was present in 12 patients. Statistical analysis revealed significant correlations between early functional deterioration and preoperative Karnofsky scale scores, male gender, radiological findings of the absence of an arachnoid plane, edema of the brain stem, and arteriographic supply from the basilar artery. Operative features included difficulty with dissection, an absent arachnoidal cleavage plane, and incomplete tumor resection. Permanent functional deterioration was statistically associated with the following: blood supply from the basilar artery, difficulty of dissection, incomplete tumor resection, and early postoperative dysfunction. Logistical regression analysis revealed that the most important risk factor for early postoperative deterioration was tumor size. Patients with large or giant tumors had a 6.7 to 13 times greater risk of functional deterioration, respectively, than patients with small- or medium-sized tumors. Excluding tumor size, the most important factor for permanent deterioration was blood supply from the basilar artery. Patients in this category had a 4.4 times greater risk of permanent functional deterioration.Three stages of tumor relationship to the brainstem arachnoid and pial membranes are proposed. Based on the results of this clinical study of clival meningiomas, suggestions are made for changes in the management strategy of these difficult lesions.